BJC Chief Executive Steven Lipstein attributed the layoffs, which were announced last week, to several factors involving government cuts and reduced rates of hospital use. He said BJC and many other health systems across the nation experienced a 2 to 3 percent downturn in Medicare revenue in the first quarter of 2013 and a lower operating margin because of government budget cuts.

BJC's hospital patient admissions and emergency room services have also declined, he said.

BJC has tried to boost revenue with more efficient billing and collections, and to lower costs through employee attrition, better management of medical supplies, more efficient use of information technologies and streamlining its administrative expenses, Lipstein said.

"We will always consider layoffs a last resort," he said, adding that any future BJC layoffs will depend largely on actions by state and federal government. "For us, these are our colleagues, our employees, our friends. This is very unusual for us."